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Competency: Alternatives to Opioids Last Revision: 07/19/2019

Learn about ALTO principles and the CERTA approach to pain management, including non-opioid alternatives and strategies for introducing ALTO medications to patients and families. Explore the Society of Hospital Medicine guidelines for opioid prescribing and treatment.

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Competency: Alternatives to Opioids Last Revision: 07/19/2019

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  1. Competency: Alternatives to OpioidsLast Revision: 07/19/2019 Revised 8/19/19

  2. Question 1 What is an ALTO? • Multi-modal non-opioid approach to analgesia for specific conditions • Alternative therapies for pain • Alternatives to opioids • Non-opioid medications first • All the above

  3. Question 2 Which of the following represent(s) ALTO Principles? • Discuss opioid side effects and abuse potential with the patient • Use opioids as a rescue drug • Discuss realistic pain relief goals • A and C

  4. Question 3 What is the Channels-Enzymes-Receptors Targeted Analgesia (CERTA) approach to pain management? • Targeted, patient-focused analgesic approach to pain management • A combination of non-opioid analgesics that is not evidenced-based but anesthesiologists like to use anyway • Can sometimes be useful but can often increase side effects • Often increases the length of stay • A shift from the mechanistic approach to symptom-based approach in treating pain

  5. Question 4 Which of the following pathways are included in the Rocky Mountain Chapter of the Society of Hospital Medicine 2019 Opioid Prescribing and Treatment Guidelines? • Renal Colic • Pleuritic Pain • Extremity Pain • Abdominal Pain • All the above

  6. Question 5 What are some critical success factors when introducing an ALTO medication to a patient or family member? • Educate yourself on how old drugs are being used in new ways • Sit and talk with the patients and/or family members and explain how old drugs are being used in new ways • Update the patient whiteboard with positive and encouraging comfort level verbiage using ALTO and non-pharmacological treatment modalities • Work with case management, clinicians, therapists and providers to ensure everyone is aligned with the same messages • All the above

  7. Question 6 According to the CO's CURE Hospital Medicine pathways, lidocaine topical patches are a first-line therapy for pleuritic pain. • True • False

  8. Question 7 According to the CO's CURE Hospital Medicine pathways, gabapentin is considered a second-line therapy for extremity pain. • True • False

  9. Question 8 What is the most important side effect to consider when administering IV lidocaine? • Prolonged QT • Hypotension history • Cardiac history • Renal history • Diabetes history

  10. Question 9 Dicyclomine can be administered as a slow IV push. • True • False

  11. Question 10 Ketamine must be used with caution in patients with significant psychiatric history and avoided in patients with PTSD and mania. • True • False

  12. Question 11 Acute pain is defined as lasting less than six months, is directly related to an injury and is more severe than chronic pain. • True • False

  13. Question 12 Chronic pain is always treated with opioids. • True • False

  14. Question 13 Chronic pain is the least common cause of long-term disability. • True • False

  15. CO’s CURE Hospital Medicine Pilot Attestation • I have read and understood the goals, objectives and the implementation of (name of hospital) CO’s CURE Hospital Medicine Program, including an understanding of the Society of Hospital Medicine 2019 Opioid Prescribing and Treatment Guidelines, the pharmacologic guideline and pathways. • True • False

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